Hepatitis B testing and treatment in HIV patients in The Gambia - compliance with international guidelines and clinical outcomes

Background Compliance with WHO guidelines on HBV screening and treatment in HIV-coinfected patients is often challenging in resource limited countries and has been poorly assessed in sub-Saharan Africa. Methods Between 2015 and 2016, we assessed physician’s compliance with WHO guidelines on HIV-HBV coinfection in the largest HIV clinic in The Gambia, and the hepatic outcomes in HIV-HBV coinfected patients as compared to randomly selected HIV-monoinfected controls. Results 870 HIV-infected patients regularly seen in this clinic agreed to participate in our study. Only 187 (21.5%, 95% CI 18.8–24.3) had previously been screened for HBsAg, 23 (12.3%, 95% CI 8.0–17.9) were positive of whom none had liver assessment and only 6 (26.1%) had received Tenofovir. Our HBV testing intervention was accepted by all participants and found 94/870 (10.8%, 95% CI 8.8–13.1) positive, 78 of whom underwent full liver assessment along with 40 HBsAg-negative controls. At the time of liver assessment, 61/78 (78.2%) HIV-HBV coinfected patients received ART with 7 (11.5%) on Tenofovir and 54 (88.5%) on Lamivudine alone. HIV-HBV coinfected patients had higher APRI score compared to controls (0.58 vs 0.42, p = 0.002). HBV DNA was detectable in 52/53 (98.1%) coinfected patients with 14/53 (26.4%) having HBV DNA >20,000 IU/L. 10/12 (83.3%) had at least one detectable 3TC-associated HBV resistance, which tended to be associated with increase in liver fibrosis after adjusting for age and sex (p = 0.05). Conclusions Compliance with HBV testing and treatment guidelines is poor in this Gambian HIV programme putting coinfected patients at risk of liver complications. However, the excellent uptake of HBV screening and linkage to care in our study suggests feasible improvements

Isolation and identification of bioactive compounds from kernel seed cake of the mango (Mangifera indica Lam)

The ethanol extract and ethyl acetate fraction of Mangifera indica kernel seed cake inhibited the growth of Staphylococcus aureus and Pseudomonas aeruginosa. The bioactive compounds were isolated and identified by NMR, UV and mass spectrometry as methyl gallate, gallic acid and penta-O-galloylglucose. Theisolated methyl gallate and penta-O-galloylglucose also showed significant antibacterial activities against Staphylococcus aureus and Pseudomonas aeruginosa.Keywords: Mangifera indica, kernel seed cake, antibacterial activity, gallic acid, penta-O-galloylglucose, methyl gallate

Risk Factors for Dementia in a Senegalese Elderly Population Aged 65 Years and Over

Background: With the aging of the population, dementia is increasing worldwide. The objective of this study was to identify risk factors for dementia in an elderly population utilizing a primary health care service in Dakar, Senegal. Methods: Through a cross-sectional study conducted from March 2004 to December 31, 2005, 507 elderly patients aged ≥65 years who came to the Social and Medical Center of IPRES, Dakar, Senegal, were first screened with the screening interview questionnaire ‘Aging in Senegal’. Those who were cognitively impaired underwent a clinical examination to detect dementia. Univariate, bivariate, and multivariate logistic regression analyses were done. Results: The whole population had a mean age of 72.4 years (±5.2) and was mostly male, married, and non-educated. Hypertension, arthritis, and gastrointestinal diseases were the main health conditions reported in the past medical history. Smoking was important while alcohol consumption was rare. Social network was high. Forty-five patients (8.87%) had dementia. In the multivariate model, only advanced age, education, epilepsy, and family history of dementia were independently associated with dementia. Conclusion: The risk factors identified are also found in developed countries confirming their role in dementia. It is important to take dementia into consideration in Senegal and to sensitize the community for prevention

Rapid Molecular Assays for Specific Detection and Quantitation of Loa loa Microfilaremia

Loa loa is a filarial nematode that infects over 10 million people in Africa. Most infections cause no symptoms, but individuals with large numbers of blood-stage microfilariae are at risk for fatal reactions to ivermectin, an antiparasitic agent used to treat and prevent infections with Onchocerca volvulus, a related filarial parasite that may occur alongside L. loa. To address the urgent need for a point-of-care L. loa diagnostic assay, we screened a Loa microfilaria gene expression library and identified 18 Loa-specific DNA targets. From two targets, we developed a novel, rapid quantitative PCR assay for estimating L. loa microfilaria burden. The assay is highly sensitive (detects a single microfilaria in 20 µL of blood) and correlates well with microfilaria counts obtained with conventional microscopic techniques. The assay is species-specific for L. loa compared with related filarial parasites (including O. volvulus) and can be used in its current form in resource-rich areas as a diagnostic tool for L. loa infection. Although modifications will be required to make point-of-care use feasible, our assay provides a proof of concept for a potentially valuable tool to identify individuals at risk for adverse reactions to ivermectin and to facilitate the implementation of filarial control programs

Impact of opportunistic diseases on chronic mortality in HIV-infected adults in Côte d'Ivoire

Objective: To estimate incidence rates of opportunistic diseases (ODs) and mortality for patients with and without a history of OD among HIV-infected patients in Côte d'Ivoire. Methods: Using incidence density analysis, we estimated rates of ODs and chronic mortality by CD4 count in patients in a cotrimoxazole prophylaxis trial in Abidjan before the highly active antiretroviral therapy (HAART) era. Chronic mortality was defined as death without a history of OD or death more than 30 days after an OD diagnosis. We used Poisson's regression to examine the effect of OD history on chronic mortality after adjusting for age, gender, and current CD4 count.Results: Two hundred and seventy patients (40% male, mean age 33 years, median baseline CD4 count 261 cells/µl) were followed up for a median of 9.5 months. Bacterial infections and tuberculosis were the most common severe ODs. Of 47 patients who died, 9 (19%) died within 30 days of an OD, 26 (55%) died more than 30 days after an OD, and 12 (26%) died with no OD history. The chronic mortality rate was 31.0/100 person-years for those with an OD history, and 11.1/100 person-years for those with no OD history (rate ratio (RR) 2.81, 95% confidence interval (CI): 1.43 - 5.54). Multivariate analysis revealed that OD history remained an independent predictor of mortality (RR 2.15, 95% CI: 1.07 - 4.33) after adjusting for CD4 count, age and gender.Conclusions: Before the HAART era, a history of OD was associated with increased chronic HIV mortality in Côte d'Ivoire, even after adjusting for CD4 count. These results provide further evidence supporting OD prophylaxis in HIVinfected patients.South African Medical Journal Vol. 96(6) 2006: 526-52

The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002-2008

Schistosomiasis remains one of the most prevalent parasitic diseases in developing countries. After malaria, schistosomiasis is the most important tropical disease in terms of human morbidity with significant economic and public health consequences. Although schistosomiasis has recently attracted increased focus and funding for control, it has been estimated that less than 20% of the funding needed to control the disease in Africa is currently available. In this article the following issues are discussed: the rationale, development and objectives of the Schistosomiasis Control Initiative (SCI)-supported programmes; the management approaches followed to achieve implementation by each country; mapping, monitoring and evaluation activities with quantifiable impact of control programmes; monitoring for any potential drug resistance; and finally exit strategies within each country. The results have demonstrated that morbidity due to schistosomiasis has been reduced by the control programmes. While challenges remain, the case for the control of schistosomiasis has been strengthened by research by SCI teams and the principle that a national programme using ‘preventive chemotherapy' can be successfully implemented in sub-Saharan Africa, whenever the resources are available. SCI and partners are now actively striving to raise further funds to expand the coverage of integrated control of neglected tropical diseases (NTDs) in sub-Saharan Afric

Improvement of Rice Production under Drought Conditions in West Africa: Application of QTLs in Breeding for Drought Resistance

Rice plays a paramount role in food and nutrition security in many West African countries. Despite the doubling of production during the last decade, rice consumption has grown faster, creating a deficit between the demand and supply. Although the West African sub-region remains the main rice-producing centre on the continent, production is severely hampered by biotic and abiotic stresses. Drought is one of the factors that most severely reduce grain yields of rice. Systems of production need to be established in order to mitigate yield loss as a result of drought. This review discusses the effects of drought on rice production in West Africa and its mitigation with an emphasis on the improvement of tolerance to drought stress. Yield stability can be achieved by developing drought-tolerant varieties through several processes encompassing profiling of known QTLs and identification of new ones, marker-assisted selection, genomic selection, and extensive multi-locational yield trials. We suggest a comprehensive strategy for breeding drought-tolerant rice varieties in West Africa

Eigenface algorithm-based facial expression recognition in conversations - an experimental study

Recognising facial expressions is important in many fields such as computer-human interface. Though different approaches have been widely used in facial expression recognition systems, there are still many problems in practice to achieve the best implementation outcomes. Most systems are tested via the lab-based facial expressions, which may be unnatural. Particularly many systems have problems when they are used for recognising the facial expressions being used during conversation. This paper mainly conducts an experi-mental study on Eigenface algorithm-based facial expression recognition. It primarily aims to investigate the performance of both lab-based facial expressions and facial expressions used during conversation. The experiment also aims to probe the problems arising from the recognition of facial expression in conversations. The study is carried out using both the author’s facial expression as the basis for the lab-based expressions and the facial expression from one elderly person during conversation. The experiment showed a good result in lab-based facial expressions, but there are some issues observed when using the case of facial expressions obtained in conversation. By analysing the experimental results, future research focus has been highlighted as the investigation of how to recognise special emotions such as a wry smile and how to deal with the interferences in the lower part of face when speaking

Level of Concordance of Pre-, Intra-, and Postoperative Staging in Cervical Cancers (TREYA Study)

Concomitant radiochemotherapy is the therapeutic standard for locally advanced (Ib2 to IVa stage FIGO) cervical cancer. In the absence of a radiotherapy in many of our Sub-Saharan African countries, surgical resection is the only therapeutic method available in hopes of achieving a definite cure. However, criteria for curative surgery are not always met due to preoperative understaging of most of our patients. In addition to socioeconomic factors, the causes for understaging are numerous. These include the lack of personnel or underqualified personnel and the absence of complete workup to assess the resectability of the tumor, but above all the lack of decision-making through multidisciplinary consultation meetings. This study makes a plea in order to provide our hospitals with qualified personnel and adequate technical platform to allow efficient management of our patients with cervical cancer